Healthcare Provider Details

I. General information

NPI: 1982126025
Provider Name (Legal Business Name): AUBREY BRUCE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 CONNECTICUT AVE NW STE 401
WASHINGTON DC
20036-1124
US

IV. Provider business mailing address

226 CHANNING ST NE
WASHINGTON DC
20002-1026
US

V. Phone/Fax

Practice location:
  • Phone: 202-505-3570
  • Fax:
Mailing address:
  • Phone: 202-505-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY1000937
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: